tbuckley/cabot-search huggingface dataset:
Abstract 9935: Association of Hypertension and Growth Differentiation Factor 15 With Incident Coronary Heart Disease: The Kuakini Honolulu Heart Program
Authors: RANDI CHEN, Brian J Morris, Timothy A Donlon, Kamal H Masaki, Eric Morgen, Kristen Fortney, Bradley J Willcox
Journal: Circulation (2022)

Introduction: Hypertension is a pathophysiological stress. Growth differentiation factor 15 (GDF15) is a stress-response protein, and a predictor for heart disease. The effects of the longevity genotype of FOXO3, a stress-response and prominent longevity-associated gene, on mortality vary in normotensive and hypertensive men. Hypothesis: The effect of GDF15 concentration on the risk of incident coronary heart disease (CHD) is different in men with different hypertension status. Methods: The Kuakini Honolulu Heart Program (KHHP) is a longitudinal study of cardiovascular diseases that started in 1965 involving 8,006 Japanese-American men in Hawaii. Proteomic analyses were performed using serum from KHHP exam 4 (1991-1993, ages 71-93) in a random sample (n=1,000) of men who in mid-life had been free of chronic diseases such as CHD, stroke, cancer, and diabetes. Participants were followed for incident CHD event (first event of MI, coronary insufficiency, angina, CABG, angioplasty, silent MI and CHD death) through December 1999. The Cox proportional hazards model was used to assess potential association of GDF15 concentration and hypertension (SBP/DBP≥160/95 mmHg or on anti-hypertensives) with incident CHD. Results: We excluded 5 men missing GDF15 data and 221 men with diseases including CHD, CHF, atrial fibrillation, LVH and stroke at baseline (KHHP exam 4). During 9 years of follow-up (median 7.92 years), 60 men developed CHD. To eliminate the possible recursive-effect of preclinical CHD on GDF15 at baseline, 6 CHD cases diagnosed within the first year of follow-up were excluded. So, there were 768 men available for analysis. Participants were divided, using tertiles of GDF15 concentration, into two groups: low-medium GDF15 (in low or middle tertile) and high GDF15 (in upper tertile). Multivariate Cox model adjusting for age, BMI, smoking (pack-years), cholesterol, HDL, diabetes and serum glucose showed a significant interaction effect of hypertension and high GDF15 on incident CHD (p=0.019); HR (95%CI) of high GDF15 vs low-medium GDF15 on CHD was 4.56 (1.51-13.76; p=0.007) in normotensive men, and 0.97 (0.49-1.92; p=0.93) in hypertensive men. Conclusions: High GDF15 concentration increases CHD risk in normotensive men, but not in hypertensive men.
Abstract 9896: Living Alone is a Poor Prognostic Factor of Mortality Among Patients With Acute Myocardial Infarction
Authors: Daichi Fukumoto, Daisuke Kanda, Yoshiyuki Ikeda, Akihiro Tokushige, Kenta Ohmure, Takeshi Sonoda, Kazuhiro Anzaki, Mitsuru Ohishi
Journal: Circulation (2022)

Introduction: Acute myocardial infarction (AMI) has been a major cause of death worldwide. Recently, living alone as a proxy for social isolation has been considered to increase the risk of cardiovascular disease. We thus investigated the impact of living alone on mortality in AMI patients. Methods: Subjects comprised 277 AMI patients who underwent percutaneous coronary intervention (PCI). Associations between all-cause death after PCI and baseline characteristics including living alone and Global Registry of Acute Coronary Events (GRACE) risk score, which is widely used for estimating mortality in AMI patients, were assessed. Results: Eighty-three patients (30%) were living alone and 194 patients (70%) were not. Median duration of follow-up was 1153 days (interquartile range, 560-1566 days). Thirty patients died after PCI including 20 cardiac deaths. Patients living alone showed higher incidences of both all-cause and cardiac deaths compared with patients not living alone (18% vs. 8%, p = 0.019 and 14% vs. 4%, p = 0.004, respectively). Multivariate Cox proportional hazards regression analysis modeling using relevant factors from univariate analysis showed living alone [hazard ratio (HR), 2.60; 95% confidence interval (CI), 1.20-5.62; p = 0.016] and GRACE risk score (HR, 1.02; 95%CI, 1.01-1.03; p = 0.003) correlated significantly with all-cause death. The interaction of GRACE risk score and living alone showed a value of p = 0.25. The optimal cut-off on the receiver-operating characteristic curve of GRACE risk score for predicting all-cause death was 162. Cox proportional hazards modeling using GRACE risk score and living alone revealed that patients living alone with GRACE risk score ≥162 showed a significantly greater risk of all-cause death than patients not living alone with GRACE risk score &lt;162 (HR 11.50; 95%CI 5.59-23.67; p &lt; 0.001). Conclusions: Among AMI patients, living alone represents an independent risk factor for all-cause death after PCI, separate from GRACE risk score. In addition, AMI patients living alone with high GRACE risk scores may experience an additively increased risk of mortality after PCI.
Abstract 9901: In-Hospital and 30-day Post-Discharge Outcomes Associated With Postoperative Atrial Fibrillation: A Contemporary Analysis From the Society of Thoracic Surgeons Adult Cardiac Surgery Database
Authors: Tae Jin Park, Darshini Shah, Patrick Gillard, William G Ferguson, Haris Subacius, Elizabeth Gray, Matthew A Romano
Journal: Circulation (2022)

Introduction: Postoperative atrial fibrillation (POAF) is associated with worse in-hospital and post-discharge morbidity and mortality. However, current estimates vary widely among published studies due to limited study centers and differing patient populations. The objective of this study was to assess the risk-adjusted in-hospital and 30-day post-discharge clinical outcomes associated with POAF in the United States. Methods: A contemporary, retrospective study was conducted using the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database. The sample consisted of patients aged 40 to 90 who underwent open-chest coronary artery bypass and/or valvular surgery between 2011 to 2019. In-hospital and 30-day post-discharge clinical outcomes were compared between those who experienced POAF and those who did not (controls). Outcomes were risk-adjusted, where appropriate, for baseline demographics and prior medical and surgical history using a multivariable regression approach. Results: A total of 424,590 patients with a mean age of 69.3 (SD 9.2) years and 1,105,200 patients with a mean age of 64.8 (SD 10.2) years were identified in the POAF and control cohorts respectively, representing a POAF cumulative incidence of 27.8%. POAF patients experienced on average a postoperative length of stay that was 2.4 days longer (p &lt; 0.001) and 32 additional hours (p &lt; 0.001) in the intensive care unit compared to control patients. After risk adjustment, POAF was associated with 64% higher odds of in-hospital stroke (OR 1.64, 95% CI 1.59, 1.69), 158% higher odds of in-hospital renal failure (OR 2.58, 95% CI 2.52, 2.64), 29% higher odds of in-hospital mortality (OR 1.29, 95% CI 1.26, 1.32), 23% higher odds of 30-day readmission (OR 1.23 95% CI 1.21, 1.25), and 27% higher odds of 30-day mortality (OR 1.27, 95% CI 1.24, 1.30). Conclusions: POAF is associated with a significantly increased risk of both in-hospital and 30-days post-discharge morbidity and mortality. This study highlights the unmet need for more effective POAF prevention strategies.
Abstract 9903: Artificial Intelligence Driven Wearable 2-minute Seismocardiography Test for Detection of Aortic Valve Stenosis Severity
Authors: Ethan M Johnson, Joshua D Robinson, Cynthia K Rigsby, Patrick M McCarthy, S C Malaisrie, Bradley D Allen, Alexander J Barker, Michael Markl
Journal: Circulation (2022)

Introduction: Standard diagnosis of aortic valve stenosis (AS) requires clinical imaging by echocardiography or cardiac MRI. The purpose of this study was to test the performance of easy to use, artificial intelligent (AI) driven seismocardiogram (SCG) chest acceleration recordings for point of care screening and identification of AS. Hypothesis: SCG measurements can be used by a low dimensional convolutional neural network (CNN) to accurately predict presence or absence of aortic valve stenosis (AS) and severity of dysfunction. Methods: This IRB approved study included 45 controls (age 46±17y, 20 F, no known cardiovascular disease) and 30 aortic valve disease (AVD) patients (age 30±20y, 7 F, 21 bicuspid). A wearable SCG device (integrated ECG/accelerometer microelectronics) was placed for 2min chest acceleration recordings on the same day as standard of care echocardiography or cardiac MRI, which was used as ground truth data to classify valve function (normal: AS-, mild AS: AS+, moderate/severe AS: AS++). A deep learning CNN (2х2 kernel, softmax/cross entropy classification) was configured to predict/detect degree of AS from spectrally decomposed SCG measurements. Randomized 50% split of subjects was used for CNN training/testing. Performance detecting AS was evaluated for classification accuracy. Results: AI driven SCG detection of valve function abnormality had high sensitivity/specificity (90%, 67%) with a net area under curve (AUC) 0.86. Correct classification of the degree of AS was achieved in 76% of subjects. Normal (AS-) vs abnormal function (AS+ or AS++) was accurately identified by AI driven SCG for 86% of subjects. Conclusions: This feasibility study demonstrates that the combination of easily measured 2 minute SCG with a deep processing pipeline could successfully detect the presence and severity of AS, supporting clinical promise for potential use as a low cost, front line screening tool to identify patients with aortic valve dysfunction.
Abstract 9825: Trajectories of Pharmacotherapy After Acute Cardiac Decompensation - Impact of Heart Failure Phenotype
Authors: Stefan Stoerk, Caroline Morbach, Guelmisal Gueder, Judith Albert, Ulrich Stefenelli, Sven-Oliver Troebs, Anna Stürmlinger, Monika Hanke, Nina Scholz, Vladimir Cejka, Stefan Frantz, Georg Ertl, Christiane Angermann
Journal: Circulation (2022)

Background &amp; Aim: Longitudinal data on prescription rates (PR) of guideline-directed medical therapy (GDMT) in patients with acute heart failure (HF) are scarce. We investigated GDMT patterns in patients with reduced (HFrEF), mildly reduced (HFmrEF), and preserved (HFpEF) ejection fraction (EF) and determined mortality risk. Patients &amp; Methods: 943 acute HF patients, consecutively recruited between 2015 and 2019, with EF measured while in hospital. PR of betablockers (BB), renin angiotensin system inhibitors (RASi), mineralocorticoid receptor antagonists (MRA), and diuretics were recorded on admission, at discharge, and 6-month follow-up. Results: Little more than one third of patients had HFrEF ( Table ). Patients with HFpEF were older and more often female. Irrespective of EF, comorbidity burden was high ( Table ). Mortality at 12 months was similar across HF phenotypes. The Figure shows that PR of all disease-modifying drug classes increased from admission to discharge irrespective of HF phenotype. PR of MRA were highest in HFrEF. After 6-months, in HFrEF patients, PR of BB (-9%), RASi (-8%), and diuretics (-10%) had decreased again to admission levels. Similar patterns were apparent in HFmrEF and HFpEF including PR of diuretics ( Figure ). Treatment discontinuation of one or more disease modifying drug classes after discharge was frequent (38% in HFrEF, 29% in HFmrEF, 39% in HFpEF). Post-discharge discontinuation was associated with an age-adjusted increase of 12-month mortality risk (OR 10.9, 95%CI 7.6–15.7): for BB 24.5 (16.0–37.5); for RASi 17.6 (11.1–28.0); for MRA 12.3 (6.9–22.1); for diuretics 27.7 (18.3–42.1), with comparable impact across HF phenotypes. Conclusion: In this cohort of patients with AHF, prescription patterns of GDMT were often changed along the HF trajectory, yet similar across HF phenotypes and time. Irrespective of HF phenotype, stopping GDMT was associated with a consistently increased mortality risk.
Abstract 9972: Sex-Related Differences and the Influence of Pregnancy on Cardiac Outcomes in Adults With a Systemic Right Ventricle and Biventricular Physiology
Authors: Naima-Ayane Mahdi, lea guerma, Francois P Mongeon, Annie Dore, Blandine Mondesert, Paul Khairy, Line Leduc, Elisabeth Codsi, Marie Chaix
Journal: Circulation (2022)

Introduction: Transposition of the great arteries (TGA) with a systemic right ventricle (sRV) and biventricular physiology is associated with increased morbidity and mortality. There is a paucity of data regarding sex-related differences in outcomes in the context of a sRV. Moreover, pregnancy has been associated with deterioration of sRV function in short-term post-partum follow-up, but the long-term impact remains largely unknown. Methods and Results: A retrospective cohort study was conducted on 214 adults, age 44.7±12.3 years, with a sRV and biventricular physiology followed for a median of 13 years at an adult congenital heart disease center. No sex-related difference was identified in the prevalence of atrial or ventricular arrhythmias, permanent pacemaker implantation, hospitalization for heart failure, systemic atrio-ventricular valve intervention, heart transplant, or cardiac death. Among the 82 (38.3%) women, age 44.0±12.5 years, 43 (52.4%) had at least one full-term pregnancy. Women had a lower prevalence of moderate to severe sRV dysfunction than men (21% vs 42.6%, p=0.001) despite similar ages. Beta-blockers (p=0.008), furosemide (p=0.012), and mineralocorticoid receptor antagonists (p=0.028) were less frequently prescribed to women than men. Women had fewer implantable cardioverter-defibrillators (ICDs) for primary prevention than men (3.7% vs 13.6%, p=0.016), with no difference in the prevalence of secondary prevention ICDs (1.2% vs 2.3%, p=1). The four women with a prohibitive maternal mortality risk (modified WHO class IV) complied with recommendations to avoid pregnancy. After excluding these 4 women, no differences regarding frequency of adverse cardiac events, age at the time of event, and proportion with moderate or severe sRV dysfunction were observed in women with (N=43) and without (N=35) pregnancies during 14 years of follow-up. Conclusions: Women with TGA and a sRV had a lower prevalence of moderate to severe systemic ventricular dysfunction than men, along with a lower proportion of primary prevention ICDs. Following risk assessment and counselling with contraindication of pregnancy in the highest risk subgroup, pregnancy had no impact on long-term cardiac outcomes.
Abstract 9983: The Effect of Congenital Heart Disease on Employment, Neuropsychological Outcomes, and Quality of Life in Adults With Down Syndrome
Authors: Stephanie S Gaydos, Kimberly E McHugh, Paul J Nietert, Andrew M Atz
Journal: Circulation (2022)

Introduction: Individuals born with congenital heart disease (CHD) and people with Down syndrome (DS) are distinct populations now living well into adulthood. These groups share risks of reduced employment, neuropsychological impairment, and poor quality of life (QOL). CHD occurs in 40-60% of people with DS; is it unknown whether CHD mediates these outcomes among adults with DS. Hypothesis: There are lower employment rates in adults with both DS and CHD. Methods: This was a cross-sectional survey of adults ages 18-45 years with DS and their guardian. Study advertisements were sent to the NIH Down Syndrome Registry, regional DS groups, and cardiology clinics. The study survey included self or proxy-reported medical history, employment and volunteer experience, quality of life (WHO-QOL-Disabilities module), mental health problems (self-report plus Glasgow Depression Scale), and caregiver burden (Zarit Burden Interview). Outcomes were compared between groups: DS+CHD and DS-CHD. Results: 287 participants completed the study, out of roughly 1100 eligible subjects recruited. 36% (n=104) reported having CHD. Most CHD types were atrioventricular canal or atrial/ventricular septal defect, and 56% reported cardiac surgery in the first year of life. There were no significant differences in subject age, sex, or trisomy 21 type between groups. There were similar rates of paid employment in those with and without CHD (54% vs. 50% respectively, p= 0.50). DS+CHD subjects reported significantly more volunteer activity (32% vs. 19%, p&lt; 0.01). Overall cohort history of stroke was 3%, seizure 12%, and mental health problems 69%. There were significantly higher rates of stroke and seizure in DS+CHD subjects (p&lt; 0.01 for both), though no difference in mental health problems (p=0.67). Self-reported mean QOL score was 66.6± 12.1 (scale 1-100 with 100 indicating best quality), with no significant difference between groups (p= 0.52). Caregiver burden was significantly greater in DS+CHD (p= 0.03). Conclusions: Having CHD is not associated with reduced employment in adults with DS, despite higher prevalence of stroke and seizures. Volunteer participation is more common in those with CHD. Mental health problems and reduced QOL are prevalent in adults with DS regardless of CHD.
Abstract 9882: Mortality Risk Factors Among Takotsubo Syndrome Patients In The United States; Insight From The National Inpatient Sample
Authors: Nomesh Kumar, Renuka Verma, Kamleshun Ramphul, Yogeshwaree Ramphul, Komal Kumari, Shaheen Sombans, Stephanie G Mejias, Syed Rashid Ali, Jyotsnav Joynauth, Petras Lohana, Fnu Arti
Journal: Circulation (2022)

Introduction: Takotsubo cardiomyopathy, also known as Takotsubo syndrome and Broken heart syndrome, is a temporary cardiovascular abnormality affecting the apical region primarily. While most cases are believed to affect post-menopausal women, we sought to address the potential risk factors for mortality in the United States. Method: Our retrospective study included patients with a principal diagnosis of Takotsubo Syndrome (ICD-10 code “I51. 81”) from the 2019 National Inpatient Sample (NIS). We searched and compared various variables and risk factors for in-hospital death via their appropriate ICD-10 codes. The Multivariable analysis allowed us to identify and adjust possible risk factors for mortality. Finally, the mean age, mean length of stay(LOS), and mean charges were also calculated. Results: In 2019, there were 8920 cases of Takotsubo syndrome requiring hospitalization.140 patients died (1.57%). Females (aOR 0.499, 95% CI: 0.320-0.779, p&lt;0.01) were less likely to die compared to males, while those with diabetes (aoR: 3.087, 95% CI: 2.140-4.454, p&lt;0.01), hypertension (aOR: 1.716, 95% CI: 1.118-4.454, p=0.013), and chronic pulmonary disease (aOR: 1.545, 95% CI: 1.063-2.246, p=0.023) were risk factors for in-hospital mortality. Moreover, patients dying were older (mean age 75.54 vs. 67.11), had a prolonged (LOS 6.11 days vs. 3.56 days), and costlier (mean charge $132,421.97vs. $54,792.96) stay. Conclusions: While Takotsubo affected more females than males, males showed a higher mortality risk. Additional risk factors included diabetes, hypertension, and chronic pulmonary disease.
Abstract 9985: Thirty Day Readmission Outcomes of Percutaneous Left Atrial Appendage Occlusion in Patients With Cancer
Authors: Yaqi Zhang, Zhuoran Yang, Raquel Soon-Shiong, Muhammad Usman Almani, Bolun Liu
Journal: Circulation (2022)

Introduction: Percutaneous left atrial appendage occlusion (LAAO) has been rapidly evolving since FDA’s approval in 2015, and has become more of a same-day-discharge procedure. Cancer patients who underwent LAAO are known to have more inpatient complications and longer hospital stay. Readmission data, however, were rarely studied in this patient population. Hypothesis: Readmission burden is relatively high in cancer patients who received LAAO. Methods: Data were derived from the National Readmission Database from 2016 to 2019. Patients with primary diagnosis of atrial fibrillation or flutter admitted for percutaneous LAAO (ICD-10 code 02L73DK) were grouped by cancer as a secondary diagnosis. We assessed inpatient mortality, length of stay, total charges and procedure complications from index hospitalization. We also compared readmission rate and most common readmission reasons. Stata SE 17.0 was used for data analysis. Results: There were 49882 index hospitalizations for LAAO, among which 1545 (3.1%) patients had a secondary diagnosis of cancer. From index hospitalizations, Patients with cancer had higher inpatient mortality (0.65% vs 0.14%, p=0.007), longer length of stay (1.54±0.08 vs 1.31±0.01, p&lt;0.001) and higher total charges (120.25±3.44 vs 117.29±2.40, p&lt;0.001). There was no statistical significance of 30-day readmission rate between patients with cancer and patients without cancer (10.0% vs 9.1%, p=0.34). The most common readmission reason in cancer patients was gastrointestinal bleeding. Conclusions: Readmission utilization is comparable between patients with cancer and patients without cancer who underwent LAAO.
Abstract 9854: Socioeconomic Status: A Key Determinant of Cardiac Rehab Participation Among Medicare Beneficiaries
Authors: Mike P Thompson, Hechuan Hou, Temilolaoluwa Daramola, Donald S Likosky, Francis D Pagani, Steven J KETEYIAN, Devraj Sukul
Journal: Circulation (2022)

Introduction: Participation in cardiac rehabilitation (CR) is poor, with disparities across patient demographic and clinical subgroups. Lower CR participation and completion rates may be associated with patients residing in socioeconomically distressed communities. Hypothesis: Patients undergoing surgical and percutaneous coronary revascularization living in distressed communities have lower rates of CR participation and completion. Methods: Medicare beneficiaries undergoing coronary revascularization (July 2016-December 2018) were identified using 100% Medicare claims data. The primary exposure was the quintile of distressed community index (DCI), with 1st and 5th quintiles representing the least and most distressed communities, respectively. CR participation and completion were defined as attending ≥1 session and attending 36 sessions within 1 year of discharge based on CPT codes in outpatient files. Multivariable logistic regression was used to evaluate the relationship between beneficiary DCI quintile and CR participation and completion. Results: Among 414,730 beneficiaries, 23.4% lived in the 1st DCI quintile and 16.4% lived in the 5th quintile. Patients in the 5th DCI quintile tended to be younger, non-white, dual eligible for Medicare/Medicaid, and more comorbid. Overall, 155,872 (37.6%) patients participated in ≥1 CR session, and 45,591 (29.3%) of those patients completed all 36 sessions. CR participation decreased as DCI quintile increased, with participation 12.0 percentage-points lower in the 5th vs 1st DCI quintile (Table). There were no significant differences in completion of 36 sessions across DCI quintiles. Conclusions: CR participation was significantly lower in more socioeconomically distressed communities, but there were no differences in completion rates. Strategies to reduce disparities in CR participation in distressed communities should focus on barriers to initial enrollment after qualifying events.